15D2181739 CLIA NUMBER - SAINT JOSEPH MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 15D2181739
  • Facility Name: SAINT JOSEPH MEDICAL GROUP
  • Facility Address: 611 E DOUGLAS RD, STE 309
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 335-6770
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES HIGGS COULTHARD
  • NPI Number: 1144774738
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2181739
LAB Type Physician Office
Facility Name SAINT JOSEPH MEDICAL GROUP
Street 611 E DOUGLAS RD, STE 309
City MISHAWAKA
State IN
ZIP 46545
Phone 574 335-6770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2024
Certificate Expiration Date 4/8/2026
Facility Type Physician Office
Lab Director CHARLES HIGGS COULTHARD

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This page was last updated on: 3/20/2025